|
ATTENTION:
|
Transmit for filing 3 copies of this form concurrently with either placing an order with a broker to execute sale or executing a sale directly with a market maker
|
|
1 (a) NAME OF ISSUER (Please type or print)
|
(b) IRS IDENT. NO.
|
(c) S.E.C. FILE NO.
|
||
|
PATRICK INDUSTRIES, INC.
|
35-1057796 |
000-03922
|
|
1 (d) ADDRESS OF ISSUER
|
STREET
|
CITY
|
STATE
|
ZIP CODE
|
(e) TELEPHONE NO.
|
|
|
107 W. FRANKLIN STREET
|
ELKHART
|
IN
|
46515
|
AREA CODE
|
NUMBER
|
|
|
574
|
294-7511
|
|||||
|
2 (a) NAME OF PERSON FOR WHOSE ACCOUNT THE SECURITIES ARE TO BE SOLD
|
(b) RELATIONSHIP TO ISSUER
|
(c) ADDRESS STREET
|
CITY
|
STATE
|
ZIP CODE
|
|
|
Blosser, Courtney
|
Officer
|
107 W. Franklin St.
|
Elkhart
|
IN
|
46515
|
|
3 (a)
|
(b)
|
SEC USE ONLY
|
(c)
|
(d)
|
(e)
|
(f)
|
(g)
|
|
Title of the
Class of
Securities
To Be Sold
|
Name and Address of Each Broker Through Whom the
Securities are to be Offered or Each Market Maker
who is Acquiring the Securities
|
Broker-Dealer
File Number
|
Number of Shares
or Other Units
To Be Sold
(See instr. 3(c))
|
Aggregate
Market
Value
(See instr. 3(d))
|
Number of Shares
or Other Units
Outstanding
(See instr. 3(e))
|
Approximate
Date of Sale
(See instr. 3(f))
(MO. DAY YR.)
|
Name of Each
Securities
Exchange
(See instr. 3(g))
|
|
Common Stock
|
ETrade Financial
1271 Avenue of the Americas
|
7,500
|
$135,675 (1)
|
10,522,101
|
11/07/12
|
NASDAQ
|
|
|
New York, NY 10020
|
|||||||
|
1.
|
(a) Name of issuer
|
3.
|
(a) Title of the class of securities to be sold
|
|
(b) Issuer’s I.R.S. Identification Number
|
(b) Name and address of each broker through whom the securities are intended to be sold
|
||
|
(c) Issuer’s S.E.C. file number, if any
|
(c) Number of shares or other units to be sold (if debt securities, give the aggregate face amount)
|
||
|
(d) Issuer’s address, including zip code
|
(d) Aggregate market value of the securities to be sold as of a specified date within 10 days prior to the filing of this notice
|
||
|
(e) Issuer’s telephone number, including area code
|
(e) Number of shares or other units of the class outstanding, or if debt securities the face amount thereof outstanding, as shown by the most recent report or statement published by the issuer
|
||
|
2.
|
(a) Name of person for whose account the securities are to be sold
|
(f) Approximate date on which the securities are to be sold
|
|
|
(b) Such person’s relationship to the issuer (e.g., officer, director, 10%stockholder, or member of immediate family of any of the foregoing)
|
(g) Name of each securities exchange, if any, on which the securities are intended to be sold
|
||
|
(c) Such person’s address, including zip code
|
|||
|
(d) Such person’s address, including zip code
|
|
|
(1)
|
Aggregate market value is determined based on the closing stock price of Patrick Industries, Inc. common stock on November 5, 2012 of $18.09 per share.
|
|
|
(2)
|
Shares received pursuant to a stock grant awarded by the Issuer on October 1, 2009 and vesting on October 1, 2012.
|
|
Title of
the Class
|
Date you Acquired
|
Nature of Acquisition Transaction
|
Name of Person from Whom Acquired
(If gift, also give date donor acquired)
|
Amount of Securities Acquired
|
Date of Payment
|
Nature of Payment
|
|
Common Stock
|
(2)
|
(2)
|
Patrick Industries, Inc.
|
7,500
|
11/07/12
|
(2)
|
|
Name and Address of Seller
|
Title of Securities Sold
|
Date of Sale
|
Amount of
Securities Sold
|
Gross Proceeds
|
|
INSTRUCTIONS:
See the definition of “person” in paragraph (a) of Rule 144. Information is to be given not only as to the person for whose account the securities are to be sold but also as to all other persons included in that definition. In addition, information shall be given as to sales by all persons whose sales are required by paragraph (e) of Rule 144 to be aggregated with sales for the account of the person filing this notice.
|
ATTENTION: The person for whose account the securities to which this notice relates are to be sold hereby represents by signing this notice that he does not know any material adverse information in regard to the current and prospective operations of the Issuer of the securities to be sold which has not been publiclydisclosed. If such person has adopted a written trading plan or given trading instructions to satisfy Rule 10b5-1 under the Exchange Act, by signing the form and indicating the date that the plan was adopted or the instruction given, that person makes such representation as of the plan adoption or instruction date.
|
|
November 7, 2012
|
/s/ Courtney A. Blosser by Andy L. Nemeth, attorney-in-fact
|
|||
|
DATE OF NOTICE
|
(SIGNATURE)
|
|||
|
DATE OF PLAN ADOPTION OR GIVING OF INSTRUCTION, IF RELYING ON RULE 10B5-1
|
The notice shall be signed by the person for whose account the securities are to be sold. At least one copy of the notice shall be manually signed. Any copies not manually signed shall bear typed or printed signatures.
|